Circular of the three departments on promoting the work of charging by disease

Source: website of development and Reform Commission on January 16, 2017 fgjg [2017] No 68 development and Reform Commission, Price Bureau, health and Family Planning Commission (bureau), Department of human resources and social security (bureau): in accordance with the deployment and requirements of deepening the reform of medical and health system, 2011 In, the state launched a pilot project to reform the way of charging for diseases All localities actively selected some diseases for the pilot project and achieved preliminary results, which played a positive role in standardizing the diagnosis and treatment behavior and controlling the unreasonable growth of medical expenses In order to further implement the general office of the State Council's implementation opinions on comprehensively promoting the comprehensive reform of county-level public hospitals (GBF [2015] No 33) and Guidance Opinions on pilot comprehensive reform of urban public hospitals (GBF [2015] No 38) (No.) and the relevant spirit of the notice on printing and distributing the opinions on promoting the reform of medical service price (fgjg [2016] No 1431) issued by the national development and Reform Commission, the national health and Family Planning Commission, the Ministry of human resources and social security, the Ministry of Finance and other four departments, to further promote the reform of charging by disease The notice on relevant issues is as follows: 1 Gradually expand the scope of charging by disease On the basis of pilot reform in the early stage, all localities should further expand the number of diseases charged by disease, focus on the work of charging by disease in the areas of common and frequently occurring diseases with standardized clinical pathway and clear treatment effect, and encourage daytime surgery to be included in the range of charging by disease Public hospitals at or above the second level should select a certain number of diseases to charge according to diseases The number of diseases to be charged according to diseases in the pilot area of comprehensive reform of urban public hospitals should not be less than 100 by the end of 2017 All localities should work out the detailed rules for the implementation of charging according to diseases, and publish them to the public and organize the implementation before the end of June 2017 2、 Based on the principles of clear diagnosis, mature technology, less complications and exact curative effect, we have selected 320 diseases to be used in promoting the charging according to diseases (see the attachment for the specific catalogue) Relevant disease technical specifications will be entrusted to relevant industry associations or associations for unified release as a reference for local governments to promote the reform of disease based charging and formulate charging standards All localities can choose to carry out within 320 disease categories published by the state, or determine specific disease categories according to the local actual situation In accordance with the principle of "encouragement and restriction", all localities should set up the charging standards for diseases, and gradually establish a dynamic adjustment mechanism for the charging standards The charging standard should be based on the reasonable cost of medical services, reflect the value of medical technology and medical personnel services, and calculate with reference to the actual expenses incurred in the past In principle, the highest price limit management shall be implemented according to the disease charging standard According to the disease charging standard, it includes all the expenses of diagnosis and treatment during the period of inpatient, i.e the expenses of diagnosis, treatment, operation, anesthesia, inspection, nursing, bed, drugs, medical materials and other expenses incurred in the whole process, which are from the patient's admission to hospital, standardized diagnosis and treatment according to the disease treatment management process, and finally discharged to the efficacy standard There shall be no additional charge in addition to the disease type fee, and the examination and inspection fee after admission shall not be converted into outpatient fee 3、 We should strengthen communication and coordination among the departments of price, health and family planning, human resources and social security We should do a good job in the connection of the reform of fee collection and payment according to disease, give full play to the synergistic effect of fee collection and payment according to disease, form a joint force of policies, control the growth of unreasonable fees, and reduce the burden of personal expenses of the masses The medical insurance agency shall reasonably determine the medical insurance payment standard of the corresponding diseases through negotiation and consultation with the medical institutions, and adjust it according to the actual situation and time, taking into account the local implementation of the disease based charges, the comprehensive consideration of the bearing capacity of the medical insurance fund and the burden level of the insured personnel and other factors 4、 Conscientiously implement various reform policies, all localities should strengthen organizational leadership, establish a working mechanism of division of labor and close cooperation among departments, and pay close attention to the implementation of policies Local price and health and family planning departments should formulate policies and measures to assess the work of medical institutions charging fees according to diseases, strengthen incentives and constraints, establish reward and punishment mechanisms, and mobilize the enthusiasm and initiative of medical institutions charging fees according to diseases It is necessary to include the charge by disease into the performance evaluation system of public medical institutions, establish a supervision and evaluation mechanism for the charge by disease, determine scientific and reasonable evaluation indicators, make full use of information technology, and strengthen the evaluation and supervision of the change of the charge by disease, service efficiency and service quality Medical institutions shall not shirk the responsibility of seriously ill patients, shorten the length of stay of patients and decompose the number of stay of patients without any reason The social security department of human resources and the health and family planning department should further reform the payment method of medical insurance, strengthen the fund budget management, improve the negotiation and consultation mechanism, and scientifically formulate the payment standard by disease Charging according to disease is an important content to promote the reform of medical service pricing mechanism and establish multiple forms of coexisting pricing mode, and an important means to control the unreasonable growth of medical expenses and reduce the burden of patients All localities must attach great importance to it In the process of promoting the reform of charging by disease, we should strengthen news publicity, correctly guide public opinion, and create a good environment for promoting the charging by disease In case of new situations and problems in the reform, they shall report to the national development and Reform Commission, the national health and Family Planning Commission and the Ministry of human resources and social security in a timely manner Appendix: Catalogue of 320 diseases, Ministry of human resources and social security, national development and Reform Commission, national health and Family Planning Commission, January 10, 2017